Harri K Pihlajamäki1, Ville M Mattila2, Tuomo I Visuri1. 1. Research Department, Centre for Military Medicine, P.O. Box 50, FIN-00301, Helsinki, Finland. 2. Department of Orthopaedics, Tampere University Hospital, 33100 Tampere, Finland. E-mail address: ville.mattila@uta.fi.
Abstract
INTRODUCTION: Surgical treatment of an acute lateral ligament rupture is occasionally warranted. STEP 1 INCISION: Make a skin incision from the anterior aspect of the fibula and curve it inferiorly and posteriorly. STEP 2 REPAIR: Repair the ligaments with absorbable sutures; if there is bone avulsion, pass the sutures through drill holes or use a suture anchor. STEP 3 CLOSURE: Close the wound in layers using absorbable sutures. STEP 4 POSTOPERATIVE CARE: Cast immobilization for four weeks is followed by orthosis use for two weeks; muscle exercises are initiated on the first postoperative day. RESULTS: In our previous randomized controlled trial comparing surgical and functional treatment of acute ruptures of the lateral ligament complex of the ankle, the mean score on the Performance Test Protocol and Scoring Scale for the Evaluation of Ankle Injuries was 83 ± 11 points in the surgical treatment group and 75 ± 13 points in the functional treatment group (mean difference: 8.3 points; 95% confidence interval: -0.03 to 16.6 points). WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: Surgical treatment of an acute lateral ligament rupture is occasionally warranted. STEP 1 INCISION: Make a skin incision from the anterior aspect of the fibula and curve it inferiorly and posteriorly. STEP 2 REPAIR: Repair the ligaments with absorbable sutures; if there is bone avulsion, pass the sutures through drill holes or use a suture anchor. STEP 3 CLOSURE: Close the wound in layers using absorbable sutures. STEP 4 POSTOPERATIVE CARE: Cast immobilization for four weeks is followed by orthosis use for two weeks; muscle exercises are initiated on the first postoperative day. RESULTS: In our previous randomized controlled trial comparing surgical and functional treatment of acute ruptures of the lateral ligament complex of the ankle, the mean score on the Performance Test Protocol and Scoring Scale for the Evaluation of Ankle Injuries was 83 ± 11 points in the surgical treatment group and 75 ± 13 points in the functional treatment group (mean difference: 8.3 points; 95% confidence interval: -0.03 to 16.6 points). WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
Authors: Harri Pihlajamäki; Kalevi Hietaniemi; Mika Paavola; Tuomo Visuri; Ville M Mattila Journal: J Bone Joint Surg Am Date: 2010-09-10 Impact factor: 5.284